This health services research study will trace the outcomes of a cohort of 2,400 patients discharged from 44 skilled nursing homes in the San Bernardino/Riverside/Ontario SMSA. Patients will be followed post discharge into hospitals and the community to ascertain their ultimate outcome. Documentation describing the fate of discharged nursing home residents (skilled nursing) appears conflicting and misleading. The federal analysis of nursing home discharges indicate that 74% were discharged alive. However, Keeler et al estimate that almost half of patients discharged from nursing homes are dead or die soon after discharge. Vicente's analysis of death records estimates that only 22% of discharged residents return home, 78% die. This study will provide data to test Keeler's and Vicente's estimates of the characteristics of nursing home residents, their lenghts of stay and outcomes. The outcomes of three categories of patients generally defined as live discharges will be described: persons discharged home; persons admitted to hospitals; persons transferred to skilled nursing facilities. Our preliminary work suggests that nursing home residents move back and forth between hospitals, nursing homes and other long term care facilities. We will describe this dynamic picture in terms of "episodes" of nursing home care, i.e. a period of continuous institutional care involving nursing homes and hospitals, terminating in either death or discharge to a non-institutional setting. A four year follow-up will be conducted on the patient cohort discharged alive from hospitals, transferred to skilled nursing facilities and discharged home. The predictive variables are organized in three general areas: individual characteristics; care requirements and social support. Outcomes are noted at three points in time: immediate discharge status from the nursing home, post discharge status from the hospital and four years following discharge from the nursing home.